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The NIH Keeps Up With The Times: 1, 2,
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Robert Gallo on The Force of Ejaculation: ***, on HIV Theory: ***, Lectures in Marseilles: ***.
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John Mellors Sets the Record Straight: ***.
Bono, el Magnifico, Holds (Another) Press Conference: ***.
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Anthony Fauci and David Ho Disprove an Old Adage: ***.
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The CDC Can't Keep Up With The Times:***
The Method of the "Small Inquisitor" Moore:***
The Co-Discovery of a Nobel-Worthy Enzymatic Activity:***
The Revenge of the "Very" Minor Moriarty:***
Julie Gerberding and Anthony Fauci Learn Arithmetic:***
Osama Obama Has a Message for Africa:***

August 10, 2006

The Padian Waffle!

Some of the usual knuckleheads at another site have posted a little piece on our favorite epidemiologist, the ditzy Dr. Nancy Padian:

One of the more egregious myths perpetrated by AIDS denialists is that HIV is not heterosexually transmitted. Part of the "evidence" that underlies this myth is a 1997 paper by Dr. Nancy Padian and her colleagues at the University of California, San Francisco (Padian NS, Shiboski SC, Glass SO, Vittinghoff E. 1997. Heterosexual transmission of human immunodeficiency virus (HIV) in Northern California: results from a ten-year study. Am J Epidemiol 146, 350-357) (1). The denialists either misinterpret or misunderstand this paper. Some internet sites/Blogs even go so far as to suggest that the "HIV/AIDS establishment" (sic) finds Dr. Padian's work inconvenient and has suppressed it, to the detriment of her professional career. The following commentary from Dr. Padian addresses HIV heterosexual transmission, discusses what her seminal 1997 paper does actually say and, ipso facto, speaks to the absurdity of the notion that her work has been suppressed, or is inconvenient to other AIDS researchers.

Isn't it funny how these stooges cannot even address the salient facts of the Padian paper? In fact, few of 'em ever even heard of the paper, until, ahem, yours truly started beating 'em over the head with it at Tara Smith's blog.

Then, these jokers trot out ditzy Nancy to pontificate a bit:

HIV is unquestionably transmitted through heterosexual intercourse. Indeed, heterosexual intercourse is now responsible for 70-80% of all HIV transmissions worldwide

Hmm. That's quite a bold statement, Nancy. Have epidemiological studies in the USA backed this up?

A common practice is to quote out of context a sentence from the Abstract of the 1997 paper: "Infectivity for HIV through heterosexual transmission is low".

Well, that's because infectivity for HIV is low. You estimated 1/1000 sex acts for a woman to get it from an infected man, and 1/10,000 for a man to get it from an infected woman. But,here is my absolutely favorite part:

"That we witnessed no HIV transmissions after the intervention documents the success of the interventions in preventing the sexual transmission of HIV"

So, lemme get this straight. You observed hundreds of discordant HIV+ couples for 6 years, having kinky sex of all types -- and NOT ONE, SINGLE, SOLITARY PERSON CONTRACTED THE VIRUS?!!?

Ok, that sure is an "inconvenient truth" as Al Gore might say. But, that doesn't deter the AIDS zealots -- they PREVENTED infection with all their wonderful interventions, where condoms had a whopping, majestic, infallible success rate of 100%!!! Er, no: Ditzy Nancy forgot an important paragraph in her own paper:

"Nevertheless, the absence of seroincident infection over the course of the study cannot be entirely attributed to significant behavior change. No transmission occured among the 25 percent of couples who did not use condoms consistently at their last follow-up nor among the 47 couples who intermittently practiced unsafe sex during the entire duration of follow-up" (Padian, pg 356.)

Ooops!!!

Here's the bottom line on the Padian Paper:

1. It was the largest and longest epidemiological study of heterosexual transmission of HIV in America. (Padian, pg 354.)

2. Not a single person in the prospective study contracted HIV, despite lots of sex with HIV+ individuals. (Padian, pg 354.)

3. A significant portion did not wear condoms consistently, including 47 couples whom Nancy described has having "unsafe sex." I repeat:

Nevertheless, the absence of seroincident infection over the course of the study cannot be entirely attributed to significant behavior change. No transmission occured among the 25 percent of couples who did not use condoms consistently at their last follow-up nor among the 47 couples who intermittently practiced unsafe sex during the entire duration of follow-up" (Padian, pg 356.)

I'm sorry, Nancy, since nobody got HIV, what was so "unsafe" about the sex again?

In sum, the scientific facts of this large study decimate the purported link between HIV transmission and sex. More so, even if trivial amounts of HIV can be infrequently transmitted sexually, it surely doesn't account for the "epidemic" of 1 million people in the US who have HIV per the CDC.

Comments

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Good and fair responses, all around.

I will consider putting up a post that highlights, once again, the frailties of this testing modality.

In the meantime, I accept HB's future caveat: "if we accept that the tests mean anything... which they don't."

I think that has to be placed firmly into every discussion, for the primary reason that it is true.

For the roundness of argument, I'll accept the lovely Rebecca's notes on greet them where are --- but with that subscript in place: "there is no such thing as an HIV test."

Whatever else is being fought, whatever brand of microbiological existentialism is being bandied, the reality is that the tests function as the scarlet letter that puts the rest of the hypnosis over on folks who have never been given a fair read of the contentious material surrounding the paradigm...

So, do it for me, and email me when it comes up in debate. I'll show up.

Hey all. I was just looking at the "Words of Rebecca Culshaw" thread at Tara's Aeitiology blogsite, and it seems that Tara is trying to spank the rethinkers with the "New and Improved" politcal statements of Nancy Padian posted on Moores Aidstruth.

Ole honest Abe Lincoln is over there stating the obvious, but wow, seems like you shook them all up Hank with your Padian Report.

I am not Dr. Culshaw, and did not have a chance to read your educational posting re HSV-2. Perhaps you would care to reposition it. If you do, I trust you will provide in context quotations and full citations for any literature you cite. You have no authority as an anonymous automobile to expect any one to take you at your word.

The frequency of genital HSV-2 acquisition increased with the reported frequency of sexual activity and was 0.35 per 1000 sexual contacts among the susceptible partners of valacyclovir recipients, as compared with 0.68 per 1000 sexual contacts among the susceptible partners of placebo recipients. The respective rates of acquisition among susceptible women were 0.60 and 1.27 per 1000 sexual contacts and, among susceptible men, 0.23 and 0.35 per 1000 sexual contacts.

Despite counseling, 37 percent of the couples reported at each monthly visit that they never used condoms for vaginal or anal intercourse at all during the study, 20 percent reported that they used condoms more than 90 percent of the time, and 43 percent reported that they used them between 1 and 90 percent of the time.

Indeed, you have educated us all on the difference between a study that can report real data and one that draws its quantitative conclusions from meta-statistical withcraft.

It does of course absolutely nothing to call into question anything at all Dr. Culsahw or others have written, none of which is based on the made up out of tattered cloth estimates Padian et al. produce.

You might also take note of perhaps the most critical point of this study in regard to the matter udner discussion here. Namely, a real infection was documented sufficient number of times to make rather precise estimates of the contact rates, and when combined with the number of infections in the population this indeed makes for a relatively easily transmissible agent. Compare this to the 10 years of 0 that the multicenters found.

Hi Pontiac. I would assume, if the odds ratios you reported earlier are generally considered accurate, and have been replicated in other studies, then it would be safe to assume that if the couples in Padian were tested for HSV-2, the odds of transmission would have been exactly the same as found in previous studies.

I need no calculator, nor does anyone else, nor any knowledge of statistics to answer your 'question' Pontiac.

If HSV-2 was even close to as difficult to horizontally transmit "in the wild", like they say, as HIV-1 (2...n) there would never have been an actual outbreak of genital herpes in the US that affected almost everyone.

And though I have not checked, I believe the CDC estimates of prevalnce in the US population for 25 years are not constant.

I seem to remember this particular herpes paper coming up at aetiology several months ago. It's one they love to bring out to confuse people. Do a google search for her site and the thread will probably come up.

This is a typical example of "you don't believe pigs can fly just because someone tells you pigs can fly". If HSV-2 were really this difficult to transmit, there never would have been an actual herpes outbreak in the US.

I remember the first time this article was mentioned at aetiology, it blew my mind. Pigs can't fly, people.

I don't remember precisely, but the particular study I read said they strongly counselled all participants to abstain from intercourse during outbreaks, which is of course the very time when it is easiest to transmit HSV-2, way easier than during asymptomatic periods.

I have read that

(a) 50 million Americans over age 20 have antibodies to HSV-2

(b) ***When couples abstain from intercourse during outbreaks***, the annual risk of transmission is roughly 5-10%

The conclusion seems pretty obvious to me: a lot of people have sex during outbreaks. Big surprise.

Thank you Dr. Brown. Mea culpas. 1. I was too lazy and enjoying my grandchildren too much to take any additional time to read the link Pontiac sent and since it appeared to be from a NEJ paper, and reported precise rates, I assumed the rates were representative of what the Pontiac wished them to be.

A little while ago, as I was trying to take a well deserved nap, I did some "back of the envelope" mental calculations using the 1 per 1000 figure as a real value and a million infections and assuming a million encounters per week, and could not produce anything except the most pitiful arithmetically increasing number of infections, which I knew could not represent anywhere near the number of herpes cases in the O so promiscuous USofA. I was disturbed and about to adjust my previous comment about that rate x a *lot* of infections and therefore a lot of contacts could easy transmission make. Now that I see how the study was done, I can return to my nap time without losing my few remaining marbles, and only need mea culpa 2, that my instant "quantitative" explanation was made of fluff, and not the 'fluff' that dreams are made of :).

None of this of course does anything to make the meta-statistical, invented rates of Padian any more reliable.

What model are you may I ask? I just checked the link you provided, expecting to find an abstract at least of the paper whose findings you confidently reported, and to discover that like the Padian paper one needs to actually read what is written in the body to learn what the researchers actually did and found. I was perfectly willing to chalk this up to one more instance of the sloppy scholarship of those who would rather die than admit the NIH and Pasteur and Wellcome Trust and CDC and WHO might be a bit mistook in their 25 years of global pandemic death doom and destruction.

But it was worse than that man with the moniker of an automobile running on one cylinder and 4 flat tires, the link opens on the NEJ online registration page and even were I to take advantage of their FREE offer of limited access to special papers 6 motnhs old or older, I would not have been able to discover whether this was among the specials since you gave no bibliographic citation.

When I was a university professor if any student had dared to follow instructions as plain as the ones I issued you with such contempt, they would have been thrown out of my class with no discussion and no reprieve.

Another quite "comprehensible" way to put it, consistent with Peter Duesberg's molecular assessment(no cell-free transmission): No, absolutely zero evidence of heterosexual (or MTC for that matter), transmission of a "viral load"; given the known structural instability of the so-called virions, it is biologically impausible.